Performance management includes activities that ensure that organisation goals are consistently being met effectively and efficiently. The performance appraisal is a review and discussion of an employee's performance of assigned duties and responsibilities. Presently, in the Eastern Cape Department of Health, the performance appraisal tool used is the Performance Management and Development System (PMDS). Despite its policy's review over the years, workers are of the opinion that it does not eliminate the problems encountered while implementing PMDS. The Balanced Scorecard (BSC) which could be integrated with the PMDS in order to identify performance enhancement and to help promote professional growth. The Balanced scorecard ensures that the visions and goals of the organisation are met, ensuring strategic decision making at the top management level. An Organisation can develop its vision or strategic intent in order to achieve its mission and implement its strategies. The Organisation's ability to be a success depends on the performance of its staff and the BSC which also help in aligning their performance and the strategies would be useful. The PMDS and BSC combined would not only be a measurement system but also a management system that enables organisation to identify their strategies and transform them into actions.